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Original Investigation
May 26, 2003

In-Hospital Mortality Following Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Author Affiliations

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University (Drs Patil, Krishnan, Lechtzin, and Diette), and Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health (Dr Diette), Baltimore, Md. The authors have no relevant financial interest in this article.

Arch Intern Med. 2003;163(10):1180-1186. doi:10.1001/archinte.163.10.1180

Background  Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent cause of hospitalization in the United States. Previous studies of selected populations of patients with COPD have estimated in-hospital mortality to range from 4% to 30%. Our objective was to obtain a generalizable estimate of in-hospital mortality from acute exacerbation of COPD in the United States and to identify predictors of in-hospital mortality using administrative data.

Methods  We performed a cross-sectional study utilizing the 1996 Nationwide Inpatient Sample, a data set of all hospitalizations from a 20% sample of nonfederal US hospitals. The study population included 71 130 patients aged 40 years or older with an acute exacerbation of COPD at hospital discharge. The primary outcome assessed was in-hospital mortality.

Results  In-hospital mortality for patients with an acute exacerbation of COPD was 2.5%. Multivariable analyses identified older age, male sex, higher income, nonroutine admission sources, and more comorbid conditions as independent risk factors for in-hospital mortality.

Conclusions  Mortality during hospitalization in this nationwide sample of patients with acute exacerbations of COPD was lower than that of previous studies of select populations. This estimate should provide optimism to both clinicians and patients regarding prognoses from COPD exacerbations requiring hospitalization. Our results indicate that the use of administrative data can help to identify subsets of patients with acute exacerbations of COPD that are at higher risk of in-hospital mortality.